Provider Demographics
NPI:1447005285
Name:MATER, NICOLE JO
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:JO
Last Name:MATER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3257 W 20TH ST STE 200
Mailing Address - Street 2:
Mailing Address - City:GREELEY
Mailing Address - State:CO
Mailing Address - Zip Code:80634-6550
Mailing Address - Country:US
Mailing Address - Phone:970-672-4667
Mailing Address - Fax:
Practice Address - Street 1:3257 W 20TH ST STE 200
Practice Address - Street 2:
Practice Address - City:GREELEY
Practice Address - State:CO
Practice Address - Zip Code:80634-6550
Practice Address - Country:US
Practice Address - Phone:970-672-4667
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-23
Last Update Date:2024-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health